Dr. Carol Edelstein is a psychiatrist in private practice in Los Angeles, California, and has a particular interest in eating disorders. She describes a case below that falls in that vague hinterland between cyclothymia and bipolar disorder, type II.
Daniel Carlat, MDDr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
We apologize in advance. But it was inevitable that TCR would eventually have to tackle what may be the most boring topic in all of psychiatry, if not medicine in general: Drug-drug interactions.
Daniel Carlat, MDDr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
Drug interactions are enormously complicated. In tried and true TCR fashion, I have tried to make this topic easier to stomach. Nonetheless, you can skip this article if you make a decision to avoid prescribing the following medications ...
Daniel Carlat, MDDr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
When it comes to Lithium, you can (thankfully) forget all about the P450 enzymes, because they don't touch this salt. Lithium enters the bloodstream, accomplishes its mysterious mood-stabilizing duties, and then is simply whisked out of the body intact by the kidneys via urine. So with Lithium, it's all about kidneys.
Neil B. Sandson, M.D.
Director, Division of Education and Residency Training
Sheppard Pratt Health System, Towson, Maryland
Author, Drug Interactions Casebook: The Cytochrome P450 System and Beyond
Dr. Sandson, you've just published the definitive casebook on drug interactions (1), and you obviously have thought long and hard about the issue. What do you think psychiatrists really need to know about drug-drug interactions?
The concept of drug-drug interactions in psychiatry surfaced surprisingly recently. In 1988, a small letter was published in the American Journal of Psychiatry by Dr. D. A. Vaughan, a psychiatrist in practice in Wichita, Kansas. Dr. Vaughan described two women he had been treating for depression with tricyclics.
Alan Ringold, M.D., is a psychiatrist in private practice in Palo Alto, California. He is particularly astute when it comes to drug interactions, and he clearly made the right call in the following situation.
Daniel Carlat, MDDr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
Side effect expert Prakash Masand once observed that “the difference between a good clinician and a great clinician is that a great clinician is better at managing side effects.”
Daniel Carlat, MDDr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
It has become more and more painful for us to prescribe SSRIs and SNRIs over the last few years. The reason? Sexual dysfunction.
Daniel Carlat, MDDr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
Yes, side effects can be your (and your patients’) friend. Here are several common clinical scenarios, culled from conversations with astute clinicians and from reflections on my own practice.